Midbrain dopamine (DA) neurons play a central role in the regulation of voluntary movement, and their degeneration is associated with Parkinson's disease. Cell replacement therapies, and in particular embryonic stem (ES) cell-derived DA neurons, offer a potential therapeutic venue for Parkinson's disease. We sought to identify genes that can potentiate maturation of ES cell cultures to the midbrain DA neuron phenotype. A number of transcription factors have been implicated in the development of midbrain DA neurons by expression analyses and loss-of-function knockout mouse studies, including Nurr1, Pitx3, Lmx1b, Engrailed-1, and Engrailed-2. However, none of these factors appear sufficient alone to induce the mature midbrain DA neuron phenotype in ES cell cultures in vitro, suggesting a more complex regulatory network. Here we show that Nurr1 and Pitx3 cooperatively promote terminal maturation to the midbrain DA neuron phenotype in murine and human ES cell cultures.differentiation ͉ Parkinson ͉ transplantation S everal transcription factors have been implicated in the regulation of mammalian midbrain dopamine (DA) neuron development. Expression of the orphan nuclear receptor transcription factor Nurr1 is initiated in postmitotic midbrain DA neuron precursors at embryonic day 10.5 in the mouse, just preceding expression of tyrosine hydroxylase (TH) (1). Nurr1 is expressed broadly at subsequent stages of development. Nurr1-deficient animals fail to express TH in midbrain DA neurons, but other midbrain DA neuron markers such as Pitx3, Lmx1b, and En1 remain unaltered during development (2-4). Thus, Nurr1 is not required for specification of the early midbrain DA neuron cell fate but does regulate a subset of phenotypic markers. At later stages, Nurr1-deficient mice lack expression of markers for midbrain DA neuron maturation, such as the DA transporter (DAT), which is relatively specific to this cell population.Expression analyses and loss-of-function knockout mouse studies have revealed roles for additional transcription factors in the specification and maturation of midbrain DA neurons, including the homeodomain proteins Lmx1b (5), Pitx3 (6-9), and En1 (10, 11). None of these factors are uniquely expressed in midbrain DA neurons, nor are they required for TH expression. However, each of these factors is necessary for the complete maturation and survival of the midbrain DA neuron population.Overexpression of Nurr1 alone in neuronal cell lines (12), primary neuronal precursor cells (13), or embryonic stem (ES) cultures (14, 15) appears to promote the expression of a subset of midbrain DA neurons markers in vitro, including TH, but this may reflect a broad proneural activity (16). Pitx3 overexpression alone in undifferentiated ES cultures or in neuron progenitor cells is not sufficient to induce a mature midbrain DA neuron phenotype but may promote expression of a subset of markers (13, 17). Thus, we hypothesized that multiple transcription factors may collaborate within a network to induce late events in midbrain DA ...